ORIGINAL ARTICLES   

Chirurgia 2006 October;19(5):327-31

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: Italian

Aneurysms of the visceral arteries: therapeutical approaches in elective treatment and in emergency. the role of laparoscopy

Senatore S., Griffa B., Sacchi F., Zanardo M., Griffa A., Capriata G.

Dipartimento di Chirurgia, Ospedale Valduce, Como

Aneurysms of the visceral arteries (VAAs) are a Heterogeneous group of lesions that can affect most of the splanchnic arteries. They are rare diseases, but, with the introduction of modern radiological techniques, they are now more commonly encountered, and approximately 3000 cases have been reported in the literature. In many cases, these lesions are initially seen in emergency, with catastrophic rupture and hemoperitoneum. In other instances, an asymptomatic visceral artery aneurysm is incidentally discovered during an abdominal utrasound scan performed for other diseases. A retrospective analysis of all VAAs diagnosed and treated at the Surgical Department of Valduce Hospital in Como, during the period from february 1995 to january 2002 was performed. Thirteen patients ( 10 women and 3 men ) affected with VAAs were admitted. The most frequent site of the aneurysm was the splenic artery ( 9 cases ), followed by the pancreatico-duodenal ( 3 cases ) and the superior mesenteric artery ( 1 case ). In ten patients, VAAs were detected before rupture: five patients (38,5%) underwent elective surgery, three with open and two with laparoscopic approach; three were treated successfully with percutaneous embolization and the last two were submitted to diagnostic arteriography only. Moreover, three patients (23%) were admitted with ruptured aneurysm and were operated on in emergency. Postoperative mortality was nil, whereas postoperative morbidity was 7,7% : a patient, admitted for hemorragic shock secondary to rupture of a pancreatico-duodenal aneurysm, developed an ischaemic stroke in the postoperative period. In conclusion, all the VAAs, because of their clinical evolution, with possible rupture, must be treated electively, either by interventional radiology, either by surgical intervention, if possible by laparoscopic approach.